Usefulness of intracardiac echocardiography-guided mapping of the tricuspid annulus in ablating the right free wall accessory pathway

Excerpt

Catheter ablation of the right free wall accessory pathway (AP) is not always easy compared to the left-sided and septal AP because of the difficulty in localizing the tricuspid annulus (TA), catheter-tip instability on the TA, and unique AP characteristics such as the broadband and multiple insertion sites in some cases [1‐4]. Identification of the TA is often challenging due to the absence of a venous structure running parallel to the TA, greater circumference than the mitral annulus, and the difference in the angle at which the valve attaches to the TA. Instability of the catheter tip results in poor tissue contact during ablation at the target site, contributing to the increased AP recurrence rate [4]. In this report, we describe the usefulness of intracardiac echocardiography (ICE) and CARTOSOUND system in accurately identifying the TA in the CARTO electroanatomical (EA) map and ablating the right free wall AP with the aid of a steerable sheath. …